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Fibroids
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An_250546 posted:
I am 59 and had my last period 20 years ago. I have also had a large fibroid for 20 years. I have developed over the past years pelvic pain with intercourse, extreme low back pain and incontinence. Yep, I hit the Trifecta! Would removing the fibroid through embolization work for me and would removing the fibroid take care of the pains and the incontinence?

Thanks for any and all responses!
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Jane Harrison Hohner, RN, RNP responded:
Dear An: Let's take each of the adverse symptoms individually, then discuss embolization, OK?

1. Urinary incontinence--if the fibroid is large enough to press against the bladder, and especially if the fibroid is on the front wall of the uterus (pushing out and restricting bladder capacity) then removal of the fibroid should fix the incontinence. However, there can be several types of incontinence--sometimes coexisting in the same woman. So if other types were present that could influence successful urinary outcome.

2. Low back pain---an enlarged fibroid uterus can be linked to a low, dragging, heavy pain which can radiate to the back. Again, if the fibroid was the sole cause of the pain, removal should assure success.

3. Pelvic pain with intercourse--fibroids by themselves tend not to be tender unless they are undergoing degradation (blood flow is cut off). But an enlarged uterus can make intercourse less comfortable.

Here from the National Library of Medicine site is a study about fibroid linked symptoms:

Fertil Steril. 2003 Jan;79(1):112-9.
The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life.
Pron G, Cohen M, Soucie J, Garvin G, Vanderburgh L, Bell S; Ontario Uterine Fibroid Embolization Collaboration Group.


Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada. g.pron@utoronto.ca

OBJECTIVE:

To determine baseline characteristics of women undergoing uterine artery embolization (UAE) for symptomatic fibroids.
DESIGN:

Multicenter, prospective, single-arm clinical treatment trial.

PATIENT(S):

Five hundred fifty-five women undergoing UAE for fibroids.
INTERVENTION(S):

Baseline questionnaires completed before UAE.
MAIN OUTCOME MEASURE(S):

Questionnaires were analyzed for demographic, medical, and gynecologic histories. Fibroid symptoms, impact of symptoms, previous consultations, and treatments were also analyzed.
RESULT(S):

The Ontario cohort (66% white, 23% black, 11% other races) had an average age of 43. Thirty-one percent were under age 40. Most women were university educated (68%) and working outside the home (85%). Women reported heavy menstrual bleeding (80%), urinary urgency/frequency (73%), pain during intercourse (41%), and work absences (40%). They experienced fibroid-related symptoms for an average of 5 years and consulted with on average of three gynecologists before UAE. High fibroid life-impact scores were reported by 58%. Black women were significantly younger (40.7 vs. 44.0 years), more likely to experience symptoms longer (7 vs. 5 years), and more likely to undergo myomectomy before UAE (24% vs. 9%) than white women.
CONCLUSION(S):

Our study illustrates that large numbers of women with highly symptomatic fibroid disease are averse to surgery despite their burden of suffering and are actively seeking alternatives to hysterectomy.

An_250546, your GYN or interventional radiologist can give you the most for sure answers about the suitability of your specific fibroid for an embolization. Size of the largest fibroid is one of the primary considerations (usually anything smaller than a 16-20 week pregnant uterus size is OK). If you have not yet consulted with a clinician who specializes in UAE, that would be my advice.

Yours,
Jane
 
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Fourfour responded:
I just turned 44. I had that procedure when I was 43. I experienced everything you have except the incontinence. Up to the point of developing fibroids, my periods were extremely light without any cramping. Since the age of 14, I have had irregular periods, I would skip 2-3 months at a time. When I developed fibroids, I stopped skipping months and my periods became longer. They became very heavy, ( I was passing clots the length of my hand and the width of the palm of my hand). I had to get a blood transfusion. I was having lower stomach and lower back pain. The pain was excruciating. After the procedure, I stopped coming on my period for a few months and there was not any pain. It has been almost a year since my procedure, and I have noticed some of the same symptoms reappearing. Each month brings a heavier period along with the pain. Butalbital is curving a lot of the pain for now. I fear that the fibroids may be regrowing. That is one of the side effects of the embolization procedure. I thought I would be in menopause if they came back, then they would shrink on their own. Your incontinence problem could be caused by a large fibroid pressing against your bladder causing leakage. I hope this has helped you.


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